Conservative Management for Arteriovenous Malformations

(HealthDay News) — For patients with brain arteriovenous malformations (bAVMs), use of conservative management is associated with better clinical outcomes for up to 12 years, compared to interventional treatment, according to a study published in the April 23/30 issue of the Journal of the American Medical Association.

Rustam Al-Shahi Salman, PhD, from the University of Edinburgh in the United Kingdom, and colleagues compared the long-term outcomes of conservative management versus intervention (any endovascular embolization, neurosurgical excision, or stereotactic radiosurgery) for unruptured bAVM in 204 patients first diagnosed from 1999–2003 or 2006–2010.

The researchers found that the 103 of 204 patients who underwent an intervention tended to be younger, more likely to have presented with seizure, and less likely to have large bAVMs, compared to patients managed conservatively. Over a median 6.9 years of follow-up, those with conservative management during the first four years of follow-up had a lower rate of death or sustained morbidity (36 vs. 39 events; 9.5 vs. 9.8 per 100 person-years; adjusted hazard ratio, 0.59; 95% confidence interval, 0.35–0.99). However, after the first four years of follow-up, rates were similar thereafter. The rate of nonfatal symptomatic stroke or death due to bAVM, associated arterial aneurysm, or intervention was lower with conservative management over the full follow-up (14 vs. 38 events; 1.6 vs. 3.3 per 100 person-years; adjusted hazard ratio, 0.37; 95% confidence interval, 0.19–0.72).

"Longer follow-up is required to understand whether this association persists," the authors write.